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A Piece of My Mind
June 11, 2019

Reflections on Leadership: Seizing and Embracing Opportunities—Holding up Half the Sky

Author Affiliations
  • 1McGovern Medical School at the University of Texas Health Science Center at Houston
JAMA. 2019;321(22):2165-2166. doi:10.1001/jama.2019.7127

On average, women are less likely than men to identify themselves as potential leaders and to seek opportunities to gain leadership skills or to take on increasingly important and complex leadership roles. I was one of those women, an unplanned and unlikely leader. I never aspired to a leadership role and never thought I would ever end up in a leadership position.

My academic journey has had a winding path defined by serendipity, unexpected choices, work in several countries, and a nontraditional but committed family life. As I’ve reflected on my career, with time spent as a clinician, a teacher, an investigator, and an administrator, serving as a department chair and now a dean, I realize that everything we do prepares us for leadership; each opportunity and each experience is a stepping-stone for increasingly complex leadership positions. Moreover, serving in a leadership role is a great privilege and has been among the most rewarding aspects of my career.

Taking care of patients and interacting with an interdisciplinary team prepares you to lead. Working with a team to put together a proposal—for a new program or research grant—prepares you to lead. Guiding other people—even in a small group—prepares you to lead. Learning from great teachers, engaged mentors, and wise colleagues prepares you to lead.

Early in my career, living and working overseas expanded my world view, introduced me to other cultures, taught me by exposure the value of diversity and inclusion, and made me optimistic that change is possible—sometimes in places where you’d least expect optimism. These experiences helped set the stage for leadership.

Although I was late to leadership training myself, taking my first formal course at the American Association of Medical Colleges as a new dean, I am a strong advocate for leadership training. At the urging of a colleague, I sponsored a leadership program when I was department chair and have sent numerous faculty members to local and national leadership training programs as a dean. The value of a leadership development program goes far beyond the actual course and includes learning to network and to identify career mentors.

I am often asked, what makes an effective leader? The best leaders are creative innovators who have big ideas. They want to make the impossible possible. When people tell them that the goal is too big or too visionary and can’t be accomplished, they work hard to prove the naysayers wrong. They want to make a meaningful influence.

Great leaders have a compelling vision. Moreover, they can communicate that vision and engage others to believe in the vision and work toward substantive change.

They have integrity and are respected and trusted by the groups they lead. Perhaps most important, they are optimistic about the future and able to communicate that optimism to others. They have an infectious spirit that helps get others excited.

I have always admired leaders who are humble and who are more interested in developing others and building institutions, than in promoting themselves. They spend time getting to know the people they work with, their personal lives as well as their career aspirations. They value strong personal relationships and are proud of the success of others.

Learning to listen is a very important skill and not always easy to master. Good leaders are mindful of actually hearing and considering the opinions of others. No one person is expert at everything, underscoring the importance of understanding and communicating the value that each person brings to the table. Leaders make better decisions if they seek the input of others, including those with diverse backgrounds and life experiences, if they trust and rely on the talents and competencies of those around them, and if they involve others in the decision-making process. When I was younger, I was impressed by how much the leaders around me knew. What I now realize is that one of the great joys of leadership is learning something new every single day.

Good leaders are not always successful at every venture, but they recognize and acknowledge their own mistakes, don’t blame others, and learn from those mistakes. They are more likely to take risks, in part because they are not scared away by the chance of failure.

Leadership is about moving from being the virtuoso—the technical expert or the best at what you do—to being the orchestra director, who inspires, motivates, seeks input from, and empowers others so that together you can make meaningful contributions and have a real and sustained impact.

I have been asked if leadership roles are compatible with “work-life balance.” I’m not sure what work-life balance is. It’s probably different for each person. Who you choose as a life partner does matter. I am lucky to have chosen wisely. My husband has been my greatest champion, encouraging me to do things I would never have considered. Always adventurous, he encouraged me to move to Bangladesh at a time when it was unusual to leave a US academic position to work in an overseas setting, a move that prompted senior faculty to caution that by leaving the United States I was “throwing away a promising academic career.” At each juncture, he has encouraged me to take on new adventures.

Perhaps the smartest decision I made for both life and work, early in my career, was to request a month away each year, without pay. That time, often spent working overseas, allowed me to spend more time with my family, exposed my children to the world, and equally important, provided time to reflect on life and career and to recharge my batteries. While time away without pay is not an option for everyone, I am convinced that I was a more productive—and happier—faculty member because of the time away. I worry more and more about the stressful, demanding lives of our young faculty—men and women—trying to balance building a career with building a personal life and family. Between work and family obligations, the magic ingredient that is often missing is time.

As a pediatrician, I would be remiss if I did not comment on why pediatricians have a special role to play in leadership. With increasing understanding of the importance of early life and health experiences to adult chronic disease and adult health, pediatricians are central to health and well-being across the life span. Health and disease are a combination of underlying genetics, environmental and social exposures, and social determinants of health—areas where pediatricians can take leadership roles—in science, in medicine, in public health, in advocacy, and in health policy.

Pediatricians can also serve as gatekeepers for the best interests of children, conscious of health equity, working to close the gap between rich and poor, and always vigilant about the ethical dimensions of what we do.

Although women and men are entering medicine in equal numbers, women still lag far behind men in senior academic ranks and in leadership roles at medical schools and health care systems. Women bring unique perspectives and life experiences to the table that need to be recognized and championed. To close the gap, there is increasing urgency to recognize the contributions of women and to provide them with greater opportunities for mentoring, sponsorship, career growth, and leadership roles.

With pride and hope, I’ve often quoted the Chinese saying: “Women hold up half the sky.” I am mindful of the importance of seizing opportunities for all of us, but especially for women. Unexpected opportunities arise in life, explore and embrace them. Those detours will not only enrich your career but also your life.

In a New York Times article a few years ago referring to electoral politics but relevant to many leadership roles, the authors wrote, “The problem with women is not winning, it’s deciding to run.”1 Women are hesitant to promote themselves and quick to doubt themselves. Many women, even highly qualified women, find it difficult to articulate the special qualities that they bring to the table. They underestimate their abilities. “Imposter syndrome” is rampant among women, but real imposters are very rare. Senator Susan Collins (R, Maine) was quoted in the Times article, “I have never ever had a male potential candidate say to me that he wasn’t ready, that he didn’t feel prepared enough. Over and over again, I’ve had potential female candidates say to me that they just don’t feel they’re quite ready, that they need more experience.” The confidence gap for women is real and needs to be addressed.

The winding road of my career has several messages. Perhaps most important is that we are fortunate to be members of a meaningful profession, privileged to be allowed into the lives of patients and families at their most vulnerable and to be scientists and teachers, asking and answering important questions. The best part of my current role is getting to know and work with wonderful faculty and staff, learning from them and with them, and developing a broader understanding of the various disciplines in medicine and the multiple aspects of a complex university and health care system.

As you build your own careers, find engaged mentors and forge productive relationships hopefully to last a lifetime. Seize opportunities that arise—sometimes nontraditional, sometimes outside of your comfort zone. Find champions in male and female colleagues who care about you and your life and your career. And think big.

So, a plea to everyone, but especially to women: at the right time in your life and career, consider leadership roles and if offered, seize the opportunity, and let’s all hold up our half of the sky.

Section Editor: Preeti Malani, MD, MSJ, Associate Editor.
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Article Information

Corresponding Author: Barbara J. Stoll, MD, McGovern Medical School at University of Texas Health Science Center, 6431 Fannin St, Houston, TX 77030 (Barbara.J.Stoll@uth.tmc.edu).

Conflict of Interest Disclosures: None reported.

Previous Presentation: A version of this essay was presented at a panel discussion during the Pediatric Academic Societies Meeting, April 2019, Baltimore, Maryland.

Miller  CC. The problem for women is not winning, it’s deciding to run. New York Times; October 25, 2016. https://www.nytimes.com/2016/10/25/upshot/the-problem-for-women-is-not-winning-its-deciding-to-run.html. Accessed May 2, 2019.
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